A 28-year-old male barber with no similar disease in his family admitted to our hospital because of difficulty of raising his arms in March 2003. When he was 18 years old, he broke his left clavicle. He started weight training from January 2003, then he gradually felt difficulty to raise his arms. Physical examination on admission showed weakness and atrophy of both serratus anterior muscles and there was no weakness in the other muscles. Serum CK level was 806 IU/l and CT scan of the upper thoracic levels revealed atrophy of the serratus anterior muscles on the both sides. Needle electromyography showed neurogenic change in the right serratus anterior muscle. Thus the diagnosis of bilateral long thoracic nerve palsy was made. Bilateral scapular winging (scapula alata) is commonly caused by systemic disease, especially muscular dystrophy or spinal muscular atrophy. Bilateral long thoracic nerve palsy by weight training should be known as one of the cause for the "scapula alata".
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